Oral lichen planus: A look from diagnosis to treatment.
Abstract
Abstract: Oral lichen planus (OLP) is a chronic mucocutaneous disease of unknown etiology. Its pathogenesis is multifactorial and it may affect the oral mucosa, skin and other mucous membranes. Diagnosis is based on clinic and histopathology; direct immunofluorescence techniques can also be of use. It affects about one to two percent of the population, mainly women between the fifth and sixth decades of life. In the mouth, the most affected area is the buccal mucosa, followed by the gums, tongue and/or palate. Its three most representative clinical forms are reticular, erythematous and erosive; evolution depends on the type it is. Lesion treatment is determined by the clinical form and, since no fully effective treatment has been found yet, it is directed towards controlling the disease. The treatment of choice involves topical or systemic corticosteroids, but other drugs may also be used.The aim of this paper is to gather current and relevant information about oral lichen planus: its pathogenesis, diagnosis, treatment and management.
Keywords: Oral Lichen Planus, Clinical/Histopathology Diagnosis, Corticosteroids, Neoplasms.
Liquen plano oral: Una mirada desde el diagnóstico al tratamiento.
Resumen: El liquen plano oral (LPO) es una enfermedad crónica mucocutánea de etiología poco conocida, cuya patogénesis es multifactorial, y puede afectar a la mucosa oral, piel y otras mucosas. El diagnóstico está basado en la clínica y la histopatología. Además, técnicas como la inmunofluorescencia directa pueden contribuir al diagnóstico de la enfermedad. Afecta del 1 al 2% de la población, principalmente mujeres, entre la quinta y sexta décadas de la vida. En boca, la zona más afectada es la mucosa yugal, seguido de encías, lengua y/o paladar. Las tres formas clínicas más representativas son: reticular, eritematosa y erosiva, cuya evolución varía según el tipo. El tratamiento de las lesiones depende de la forma clínica y está dirigido hacia un control de la enfermedad, ya que en la actualidad no se conoce un tratamiento del todo efectivo. El tratamiento de elección es la utilización de corticoides, en forma tópica o sistémica, aunque otros fármacos también pueden ser utilizados para el manejo de la enfermedad. El objetivo del presente artículo es recopilar información actualizada y relevante del liquen plano oral en su etiopatogenia, diagnóstico, tratamiento y manejo de la enfermedad.
Palabras clave: Liquen Plano Oral, Diagnóstico Clínico/ Histológico, Corticoides, Neoplasia.
References
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2. Georgakopoulou EA, Achtari MD, Achtaris M, Foukas PG, Kotsinas A. Oral Lichen Planus as a Preneoplastic Inflammatory Model. J Biomed Biotechnol. 2012: 759626.
3. Boorghani M, Gholizadeh N, Taghavi Zenouz A, Vatankhah M, Mehdipour M. Oral lichen planus: clinical features, etiology, treatment and management; a review of literature. J Dent Res Dent Clin Dent Prospects. 2010; 4(1): 3-9.
4. García-García V1, Bascones Martínez A, Martinelli-Kläy CP, Alvarez Fernández E, Lombardi T, Küffer R. New perspectives on the dynamic behaviour of oral lichen planus. Eur J Dermatol. 2012; 22(2): 172-7.
5. Nico M, Fernandes JD, Lourenço SV. Oral lichen planus. An Bras Dermatol. 2011; 86(4): 633-43.
6. Kaplan I, Ventura-Sharabi Y, Gal G, Calderon S, Anavi Y. The Dynamics of Oral Lichen Planus: A Retrospective Clinicopathological Study. Head Neck Pathol. 2012; 6(2): 178-83.
7. Fernández-González F, Vázquez-Álvarez R, Reboiras-López D, Gándara- Vila P, García-García A, Gándara-Rey JM. Histopathological findings in oral lichen planus and their correlation with the clinical manifestations. Med Oral Patol Oral Cir Bucal. 2011; 16(5): e641-6.
8. Anuradha Ch, Malathi N, Anandan S, Magesh K. Current concepts of immunofluorescence in oral mucocutaneous diseases, Department of Oral Pathology and Microbiology, SIBAR Institute of Dental Sciences, Takkellapadu, Guntur, India. J Oral Maxillofac Pathol. 2011; 15(3): 261–6.
9. Ismail SB, Kumar SK, Zain RB. Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation. J Oral Sci. 2007; 49: 89-106.
10. Roopashree MR, Gondhalekar RV, Shashikanth MC, George J, Thippeswamy SH, Shukla A. Pathogenesis of oral lichen planus – A review. J Oral Pathol Med. 2010; 39(10): 729–34.
11. Lavanya N, Jayanthi P, Umadevi K Rao, Ranganathan K. Oral lichen planus: An update on pathogenesis and treatment. J Oral Maxillofac Pathol. 2011; 15(2): 127-32.
12. Srinivas K, Aravinda K, Ratnakar P, Nigam N, Gupta S. Oral lichen planus - Review on etiopathogenesis. Natl J Maxillofac Surg. 2011; 2(1): 15-6.
13. Radwan-Oczko M. Topical Application of Drugs Used in Treatment of Oral Lichen Planus Lesions. Adv Clin Exp Med 2013; 22(6): 893–8.
14. Oliveira Alves MG, Almeida JD, Guimarães Cabral LA. Association between hepatitis C virus and oral lichen planus. Hepat Mon. 2011; 11(2): 132-3.
15. Zhou Y, Jiang L, Liu J, Zeng X, Chen QM. The Prevalence of Hepatitis C Virus Infection in Oral Lichen Planus in an Ethnic Chinese Cohort of 232 Patients. Int J Oral Sci. 2010; 2(2): 90–7.
16. Lodi G, Pellicano R, Carrozzo M. Hepatitis C virus infection and lichen planus: a systematic review with meta-analysis. Oral Dis. 2010; 16(7): 601–12.
17. Delavarian Z, Javadzadeh-Bolouri A, Dalirsani Z, Arshadi HR, Toofani- Asl H. The evaluation of psychiatric drug therapy on oral lichen planus patients with psychiatric disorders. Med Oral Patol Oral Cir Bucal. 2010; 15(2): e322-7.
18. van der Waal I. Oral lichen planus and oral lichenoid lesions; a critical appraisal with emphasis on the diagnostic aspects. Med Oral Patol Oral Cir Bucal. 2009; 14(7): e310-4.
19. Aguirre Urizar JM. Letter to the Editor: Oral Lichenoid Disease. A new classification proposal. Med Oral Patol Oral Cir Bucal. 2008; 13(4): e224.
20. Eisen D, Carrozzo M, Bagan Sebastian JV, Thongprasom K. Number V Oral lichen planus: clinical features and management. Oral Dis. 2005; 11: 338-49.
21. Al-Hashimi I, Schifter M, Lockhart PB, Wray D, Brennan M, Migliorati CA, Axéll T, Bruce AJ, Carpenter W, Eisenberg E, Epstein JB, Holmstrup P, Jontell M, Lozada-Nur F, Nair R, Silverman B, Thongprasom K, Thornhill M, Warnakulasuriya S, van der Waal I. Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103(S25): e1-12.
22. Van der Meij EH, Van der Waal I. Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications. J Oral Pathol Med. 2003; 32: 507-12.
23. Cortés-Ramírez DA, Gainza-Cirauqui ML, Echebarria-Goikouria MA, Aguirre-Urizar JM. Oral lichenoid disease as a premalignant condition: The controvesies and the unknown. Med Oral Patol Oral Cir Bucal 2009; 14 (3): e118-22.
24. Van der Meij EH, Mast H, van der Waal I. The possible premalignant character of oral lichen planus and oral lichenoid lesions: a prospective five-year follow-up study of 192 patients. Oral Oncol. 2007; 43(8): 742–8.
25. Mignogna MD, Lo Muzio L, Lo Russo L, Fedele S, Ruoppo E, Bucci E. Clinical guidelines in early detection of oral squamous cell carcinoma arising in oral lichen planus: a 5-year experience. Oral Oncol. 2001; 37(3): 262–7.
26. Mignogna MD, Lo Russo L, Fedele S, Ruoppo E, Califano L, Lo Muzio L. Clinical behaviour of malignant transforming oral lichen planus. Eur J Surg Oncol 2002; 28(8): 838–43.
27. Gandolfo S, Richiardi L, Carrozzo M, et al. Risk of oral squamous cell carcinoma in 402 patients with oral lichen planus: A follow-up study in an Italian population. Oral Oncol. 2004; 40(1): 77–83.
28. Eisenberg E. Oral lichen planus: a benign lesion. J Oral Maxillofac Surg. 2000; 58: 1278–85.
29. Krutchkoff DJ, Cutler L, Laskowski S. Oral lichen planus: the evidence regarding potential malignant transformation. J Oral Pathol 1978; 7: 1–7.
30. Van der Meij EH, Schepman KP, Smeele LE, van der Wal JE, Bezemer PD, van der Waal I. A review of the recent literature regarding malignant transformation of oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88(3): 307–10.
31. Lanfranchi-Tizeira HE, Aguas SC, Sano SM. Malignant transformation of atypical oral lichen planus: a review of 32 cases. Med Oral 2003; 8: 2–9.
32. Yildirim B, Senguven B, Demir C. Prevalence of herpes simplex, Epstein Barr and human papilloma viruses in oral lichen planus. Med Oral Patol Oral Cir Bucal. 2011; 16(2): e170-4.
33. Lodi G, Scully C, Carrozzo M, Griffiths M, Sugerman PB, Thongprasom K. Current controversies in oral lichen planus: report of an international consensus meeting. Part 2: clinical management and malignant transformation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100(2): 164–78.
34. Gonzalez Moles MA, Scully C, Gil Montoya JA. Oral lichen planus: controversies surrounding malignant transformation. Oral Dis. 2008; 14: 229–43.
35. Mehdipour M, Taghavi Zenouz A, Hekmatfar S, Adibpour M, Bahramian A, Khorshidi R. Prevalence of Candida Species in Erosive Oral Lichen Planus. J Dent Res Dent Clin Dent Prospects. 2010; 4(1): 14-6.
36. Rajentheran R, McLean NR, Kelly CG, Reed MF, Nolan A. Malignant transformation of oral lichen planus. Eur J Surg Oncol. 1999; 25(5): 520–3.
37. Carrozzo M, Gandolfo S. The management of oral lichen planus. Oral Dis. 1999; 5: 196-205.
38. Holmstrup P, Schiøtz AW, Westergaard J. Effect of dental plaque control on gingival lichen planus. Oral Surg Oral Med Oral Pathol. 1990; 69: 585-90.
39. Thongprasom K, Dhanuthai K. Steriods in the treatment of lichen planus: a review. J Oral Sci. 2008; 50(4): 377-85.
40. Carrozzo M, Thorpe R, Oral lichen planus: a review. Minerva Stomatol. 2009; 58(10): 519-37.
41. Carbone M, Arduino PG, Carrozzo M, Caiazzo G, Broccoletti R, Conrotto D, Bezzo C, Gandolfo S. Topical clobetasol in the treatment of atrophic-erosive oral lichen planus:a randomized controlled trial to compare two preparations with different concentrations. J Oral Pathol Med 2009; 38: 227-33.
42. Carbone M, Conrotto D, Carrozzo M, Broccoletti R, Gandolfo S, Scully C. Topical corticosteroids in association with miconazole and chlorhexidine in the long-term management of atrophic-erosive oral lichen planus:a placebo-controlled and comparative study between clobetasol and fluocinonide. Oral Dis. 1999; 5: 44-9.
43. Pramick M, Whitmore SE. Cushing’s syndrome caused by mucosal corticosteroid therapy. Int J Dermatol 2009; 48: 100-1.
44. Gonzalez-Moles MA, Morales P, Rodriguez-Archilla A, Isabel IR, Gonzalez-Moles S. Treatment of severe chronic oral erosive lesions with clobetasol propionate in aqueous solution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002; 93: 264-70.
45. Gonzalez-Moles MA, Ruiz-Avila I, Rodriguez-Archilla A, Morales-Garcia P, Mesa-Aguado F, Bascones- Martinez A et al. Treatment of severe erosive gingival lesions by topical application of clobetasol propionate in custom trays. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 95: 688-92.
46. Carbone M, Goss E, Carrozzo M, Castellano S, Conrotto D, Broccoletti R et al. Systemic and topical corticosteroid treatment of oral lichen planus:a comparative study with long-term follow-up. J Oral Pathol Med 2003; 32: 323-9.
47. Eisen D, Ellis CN, Duell EA, Griffiths CE, Voorhees JJ. Effect of topical cyclosporine rinse on oral lichen planus. A doubleblind analysis. N Engl J Med 1990; 23: 290-4.
48. Conrotto D, Carbone M, Carrozzo M, Arduino P, Broccoletti R, Pentenero M, Gandolfo S. Ciclosporin vs. clobetasol in the topical management of atrophic and erosive oral lichen planus:a double-blind, randomized controlled trial. Br J Dermatol. 2006; 154: 139-45.
49. Resende JP, Chaves Md, Aarestrup FM, Aarestrup BV, Olate S, Netto HD. Oral lichen planus treated with tacrolimus 0.1%. Int J Clin Exp Med. 2013; 6(10): 917-21.
50. Olivier V, Lacour JP, Mousnier A, Garraffo R, Monteil RA, Ortonne JP. Treatment of chronic erosive oral lichen planus with low concentrations of topical tacrolimus: an openprospective study. Arch Dermatol. 2002; 138: 1335-8.
51. Hodgson TA, Sahni N, Kaliakatsou F, Buchanan JA, Porter SR. Long-term efficacy and safety of topical tacrolimus in the management of ulcerative/erosive oral lichen planus. Eur J Dermatol. 2003; 13: 466-70.
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Published
2014-04-17
How to Cite
CÓRDOVA, Pablo; RUBIO, Aida; ECHEVERRÍA, Paula.
Oral lichen planus: A look from diagnosis to treatment..
Journal of Oral Research, [S.l.], v. 3, n. 1, p. 62-67, apr. 2014.
ISSN 0719-2479.
Available at: <https://www.joralres.com/index.php/JOralRes/article/view/joralres.2014.015>. Date accessed: 28 apr. 2024.
doi: https://doi.org/10.17126/joralres.2014.015.
Issue
Section
Reviews
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